The impact of malocclusions on oral health-related quality of life in children—a systematic review and meta-analysis
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The impact of malocclusions on oral health-related quality of life in children-a systematic review and meta-analysis
Lea Kragt 0 1 2 4 5
Brunilda Dhamo 0 1 2 4 5
Eppo B. Wolvius 0 1 2 4 5
Edwin M. Ongkosuwito 0 1 2 4 5
0 Edwin M. Ongkosuwito
1 Eppo B. Wolvius
2 Brunilda Dhamo
3 , Erasmus Medical Center , Rotterdam , The Netherlands
4 Department of The Generation R Study Group, Erasmus University Medical Center , Rotterdam , The Netherlands
5 Department of Oral & Maxillofacial Surgery , Special Dental Care and Orthodontics
Introduction A limited amount of systematic literature reviews on the association between malocclusions and oral health-related quality of life (OHRQOL) summarize inconclusive results. Therefore, we conduct a systematic review and meta-analysis on the association of malocclusions with OHRQOL in children. Methods Relevant studies were identified in Pubmed, Embase, Cochrane, Google Scholar and other databases. All studies with data on malocclusions or orthodontic treatment need and OHRQOL in children were included. Methodological quality of the studies was assessed with the NewcastleOttawa Scale (NOS). Random effects models were used to estimate summary effect measures for the association between malocclusion and OHRQOL in a continuous and a categorical data analysis. Tests for heterogeneity, publication bias and sensitivity of results were performed. Results In total, 40 cross-sectional studies were included in the meta-analyses. Summary measures of the continuous data show that OHRQOL was significantly lowered in children with malocclusions (standardized mean difference (95 % CI] =0.29 (0.19-0.38)). The summary odds ratio for having an impact on OHRQOL was 1.74 times higher in children with malocclusion than in children without malocclusions. Heterogeneity among studies was partly explained by malocclusion assessment, age of the children and country of study conduction. Conclusion Our results provide evidence for a clear inverse association of malocclusion with OHRQOL. We also showed that the strength of the association differed depending on the age of the children and their cultural environment. Clinical relevance Dentists benefit from understanding the patient differences regarding the impact of malocclusions.
Meta- analysis; Quality of life; Malocclusions; Children
Introduction
Malocclusion is one of the most common oral disorders in the
Netherlands. In 2005, half of the Dutch adolescents have had
orthodontic treatment, and in 2011, this proportion increased
to 60 % [
1
]. A variety of deviant occlusal traits exist that in
itself can vary in severity.
The concept of oral health-related quality of life
(OHRQOL) arose in the orthodontic literature to explain the
variability in professionally determined (objectively) and
patient-determined (subjectively) need for orthodontic
treatment [
2, 3
]. OHRQOL is a patient-reported outcome assessed
by questionnaires to measure the psychological impact of the
dentition. More precisely, OHRQOL is the interplay of oral
health variables such as biological and physiological
functional status, as well as personal attributes like role functioning,
social functioning and psychological functioning, that
represent the multidimensional and individual perception of oral
health [4]. In this way, it describes the standard of the oral
and related tissues which enables an individual to eat, speak
and socialize without active disease, discomfort or
embarrassment and which contributes to general well-being [
5
]. In the
last 15 years, the literature on the association of malocclusions
and OHRQOL has greatly expanded [
6
].
Most studies in the orthodontic literature on OHRQOL use
small convenience samples, which limits their evidence. In
2006, Zhang et al emphasized the impact of heterogeneous
population groups and measurement tools on the conflicting
evidence in orthodontic OHRQOL research [
3
]. Indeed, Liu
et al reviewed the literature in 2009, but found only a modest
association between malocclusion and the quality of life
among mixed ages [
2
]. A recent meta-analysis on
malocclusions, orthodontic treatment and OHRQOL in adults found a
moderate increase of OHRQOL after treatment (standardized
mean difference (SMD)(95 % CI) 1.29 (0.67–1.92)), but the
difference in OHRQOL between people with and people
without malocclusion was small (SMD (95 % CI) 0.84 (0.25–
1.43)) [
7
]. Both reviews suffered from the considerable
differences in study design.
The impact of malocclusions and OHRQOL might be
different in children than in adults as they deal differently
with disease, but also with psychological, social and
emotional factors [
8
]. In addition, children and adult
OHRQOL measures are different; thus, they should not
be investigated simultaneously. When the focus lies on
OHRQOL in children, a variety of instruments exist
without one universally accepted. One of the first instruments
used in adolescents is the Oral Health Impact Profi (...truncated)